Plantar fasciitis is a common foot disorder in which patients have pain and tenderness at the sole of the foot. Rest, exercises, orthotics, taping, cryotherapy, therapeutic ultrasound, electrical stimulation, whirlpool bath, and iontophoresis have been widely used to relieve plantar pain. Long term use of manual therapy techniques like myofascial release technique have been used in the past to reduce pain and improve ankle range of motion. The present study aimed to evaluate and compare the immediate effectiveness of myofascial release technique VS ultrasound on pain response and ankle flexibility in plantar fasciitis.

A total of 30 participants with plantar fasciitis were randomly allocated to Group A (myofascial release group) and Group B (ultrasound group). Therapeutic ultrasound with intensity of 1W/cm2 and frequency of 1MHz for 5 min was given for a single session to all the patients and then given the manual techniques. Visual analogue scale and FFI were outcome measures that were assessed pre- post-interventional.

The study demonstrated statistical significant reduction in pain, in both groups. FFI showed significant improvement in Group A (MFR) as compared to Group B (US).

Use of manual techniques like myofascial release therapy is more effective than therapeutic ultrasound alone on reducing pain and improving ankle flexibility in patients with plantar fasciitis.

Keywords: Plantar fasciitis, Myofascial release, Therapeutic ultrasound, Conventional exercises.

The human ankle/foot complex meet the stability demands of providing a stable base of support for the body in a variety of weight bearing postures without undue muscular activities and energy expenditure, and acting as a ‘rigid’ lever for the mobility demands by dampening of rotations imposed by the more proximal joints of the lower limb, being flexible to absorb the shock of the superimposed body weight as the foot hits the ground and allowing the foot to conform to the changing and varied terrain on which the foot is placed. Four of Cailliet’s criteria for normal foot are absence of pain, normal muscle balance, central heel and straight and mobile toes [1]. Plantar fascia called as plantar aponeurosis, lies superficial to the muscles of the plantar surface of the foot. It has thick central part which covers the central muscle of the 1st layer, Flexor digitorum brevis and is immediately deep to the superficial fascia of the plantar surface. It acts as a truss, maintaining the medical longitudinal arch of the foot, and assists during the gait cycle and facilities shock absorption during weight bearing activites [2]. Foot complaints are common in general practice and their incidence increases with age. Three out of four people complains of foot pain during the course of a life time [3], While approximately 20% of people aged 65 years or older complains of non traumatic foot problems [4]. Plantar fasciitis has been experienced by 10% of the population [5]. The foot is subjected to various types of injuries like laceration, contusion, ligaments sprains and rupture, fracture, penetrating wounds, etc In addition, pathologic changes are imposed on the foot by congenital abnormalities, bacterial and fungal infections and dermatologic lesions, ill fitting shoes, walking on hard surfaces [6]. Different authors have described heel pain as achilles spurs, retrocalcaneal bursitis, subcalcaneal pain, posterior heel pain, plantar fasciitis etc. Heel pain commonly occurs in weight bearing due to inflammation of thick tissue at the sole. Stress to plantar fascia may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; or being overweight [7]. Hence, causes of heel pain may be described as plantar, lateral, medial, posterior, and diffuse [8], and may either be caused due to injury to the soft tissue, bone, nerve or plantar fascia [9]. Plantar fasciitis an inflammation of the plantar fascia is one of the most common causes of foot pain in which pain and tenderness are located inferiorly at the plantar fascia origin [10]. It is more common in sports that involves running, long distance walking, dances, tennis players, basket ball players and non athletes whose occupation requires prolonged weight bearing [11]. Other causes are mechanical stress involving compressive forces making foots longitudinal arch flat [5]. Repeated micro traumas cause inflammation at the origin of the plantar fascia over the calcaneal medical tuberosity. Traction forces during the support phase on gait lead to an inflammatory process, resulting in fibrosis and degeneration [12]. There is a loss of flexibility as the disease progresses due to calcaneal tendon retraction, fatigue, fascial inextensibility, and poor mechanics [5].

Various physiotherapy treatment protocols have been advocated in the past such as rest, taping, orthotics, silicon heel cups, stretching, myofascial release and positional release therapy Electrotherapy modalities liketherape-utic ultrasound, phonophoresis, laser, microwave diathermy, iontophoresis, cryotherapy, contrast bath have been tried in past. Non weight-bearing stretching exercises have shown to helpful in reducing severe pain which occurs in the morning [13]. Therapeutic Ultrasound is a method of applying deep heat to connective tissue which plays an important role in relieving plantar heel pain by both thermal and mechanical effect on target tissue resulting in increased local metabolism, circulation and extensibility of connective tissue and tissue regeneration. To obtain increase in the viscoelastic properties of collagen, an elevation in tissue temperature of greater than 3° to 4°C is indicated [14]. Stretching of the shortened and contracted plantar flexors may positively influence an individual’s functional activities of daily living and decrease the risk of injury. Regardless of the type of fitness and rehabilitation program, the goal of stretching is to change the physical characteristics of connective tissue [15]. Myofascial release technique is a soft tissue mobilization technique mostly given in the chronic conditions that causes tightness and restriction in soft tissues. This technique has been proposed to act as a catalyst in the resolution of chronic plantar fasciitis [16]

Study design: cross – Randomized controlled trial

Study setting: MVP’S college of physiotherapy, Nashik

Duration of study- 6 months

Sample size: 30

Sampling technique: convenient sampling technique

Method of data collection the study has been approved by Institutional Ethical committee. Study Design was Randomized Controlled Trial. Patients were randomly divided into two groups. All subjects were recorded for demographic characteristic including Name, age, sex, and address, history and underlying disease. The subjects who met the inclusion criteria were asked to participate in the study, all procedure were explained to the subjects, written informed consent was obtained from each subjects prior to participation. Then the participants were divided into two groups using simple random sampling method viz, Group A & Group B consisting of 15 patients in each group. In group A patients received myofascial release, Whereas Group-B received ultrasound therapy, both the groups received conventional therapy.

Graph Pad Instat version 5 was used for data analysis in this study. Baseline characteristics of the two treatment groups namely Myofascial release group and ultrasound therapy group were compared to evaluate the success of randomization.

Table 1. Paired T test in group A for VAS

Table 2. Paired T test in group B for VAS

Table 3. Paired T test in group A for FFI

Table 4. Paired T test in group B for FFI

Table 5. Unpaired t test for VAS between group A & B

Table 6. Unpaired t test for FFI between group A & B